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Introduction
We illustrate how multimodality imaging using cardiac magnetic resonance (CMR) and 18F-fluodeoxyglucose (18F-FDG) Positron emission tomography/computed tomography imaging (PET/CT) can help diagnose a cardiac B-cell lymphoma and document treatment success.
Case Presentation
A 65-year-old woman presented to the emergency department with a 6-month history of progressive dyspnea, intermitted tachycardia, and recent weight loss. A computed tomography showed no lung embolism and no lung or abdominal tumor; however, pericardial and pleural effusion was depicted and the suspicion of a cardiac tumor in the right ventricular groove was raised. Besides confirmation of pericardial and pleural effusion (Figure 1), CMR depicted a T1 hypointense, T2 hyperintense, perfused, and heterogeneous late gadolinium enhancing mass (Figure 2) within the right atrioventricular groove, surrounding the right coronary artery and infiltrating the free wall of the right ventricle. No other primary tumor or metastasis could be found. A primary malignant cardiac lymphoma was suspected and the cytological analysis of the pericardial effusion confirmed a cardiac B-cell lymphoma. After 2 cycles of chemotherapy with rituximab cyclophosphamide–doxorubicin–vincristine–prednisone, PET/CT showed a decreased mass in size with only little 18F-FDG uptake within the same location. After completing of the entire 6 cycles of chemotherapy, CMR and 18F-FDG PET/CT revealed a complete remission with resolution of the symptoms.
Discussion
Primary malignant cardiac tumors are extremely rare and establishing the diagnosis may be challenging. Angiosarcoma and lymphoma are two most common malignant primary cardiac tumors and are usually located in the right heart. CMR is the ideal modality to differentiate angiosarcoma from lymphoma.1 18F-FDG PET/CT is helpful to differentiate a malignant from a benign cardiac tumor and to document treatment success.2,3 Multimodality imaging is crucial for early noninvasive assessment of primary cardiac tumors, helps guiding further investigations, treatment decision and allows documentation of therapeutic success.
References
Colin GC, Symons R, Dymarkowski S, Gerber B, Bogaert J. Value of CMR to differentiate cardiac angiosarcoma from cardiac lymphoma. JACC Cardiovasc Imaging 2015;8:744‐6.
Bernhard B, Gräni C. 18F-FDG PET/CT imaging in the workup of cardiac and pericardial masses. J Nucl Cardiol 2021.
Yin H, Mao W, Tan H, Zhu N, Wan Q, Shi J, et al. Role of (18)F-FDG PET/CT imaging in cardiac and pericardial masses. J Nucl Cardiol 2021.
Funding
Open access funding provided by University of Bern. No specific funding was received for this work.
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Dr. Gräni receives funding from the Swiss National Science Foundation and InnoSuisse outside of this work. Dr. Huber received funding from the Swiss National Science Foundation outside of this work. All others have nothing to disclose.
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Boscolo Berto, M., Spano, G., Rhyner, D. et al. Multimodality imaging of cardiac B-cell lymphoma. J. Nucl. Cardiol. 30, 1263–1265 (2023). https://doi.org/10.1007/s12350-022-02904-x
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DOI: https://doi.org/10.1007/s12350-022-02904-x